Wednesday, September 27, 2017

Marijuana Use May Increase Risk of Developing Opioid Use Disorder

People who use marijuana may be at a greater risk of misusing prescription opioids and developing opioid use disorder than those who do not use marijuana, according to a report published in AJP in Advance. The findings offer a key piece of information for those debating whether marijuana could drive down prescription opioid misuse and overdose.

The suggestion that broader access to marijuana might reduce prescription opioid misuse and overdose comes largely from two recent reports, Mark Olfson, M.D., M.P.H., of the New York State Psychiatric Institute and Columbia University Medical Center and colleagues wrote in the AJP paper. These studies found aggregate annual death rates from opioid overdoses were lower in states with medical cannabis laws compared with states without such laws. “Such ecologic analyses, however, provide no information on whether individual patients who use cannabis have a lower or higher risk of developing opioid use disorders,” they noted.

To determine the association between cannabis use and nonmedical prescription opioid use and disorders in individual patients, Olfson and colleagues analyzed data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). They compared the interview responses of more than 34,000 U.S. adults conducted as part of the 2001-2002 NESARC (wave 1) and its 2004-2005 follow-up (wave 2).

All diagnoses were made according to DSM-IV criteria, and nonmedical use of a prescription opioid was defined as using prescription analgesics “without a prescription, in greater amounts, more often, or longer than prescribed, or for a reason other than a doctor said you should use them” during the 12 months preceding the interview. Pain was assessed using the pain item of the Medical Outcomes Study 12-Item Short Form Health Survey, Version 2.

After controlling for demographic and clinical covariates associated with cannabis use, the authors found that cannabis use at wave 1 was associated with increased nonmedical prescription opioid use and opioid use disorder at wave 2. Among adults with pain at wave 1, cannabis use was also associated with increased nonmedical opioid use at wave 2.

“Although the great majority of adults who used cannabis did not go on to initiate or increase their nonmedical opioid use, a strong prospective association between cannabis and opioid use disorder should nevertheless sound a note of caution in ongoing policy discussions concerning cannabis and in clinical debate over authorization of medical marijuana to reduce nonmedical use of prescription opioids and fatal opioid overdoses,” the authors wrote.

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